Darzi surgeries could be staffed by a new 'staff grade' of doctors, who have not completed vocational training.

PCTs have had 'broad hints' that the government will try to change the regulations in time to allow two or three 'GPs' in each of the DoH's planned new surgeries to be untrained.

The DoH is using its five-year Equitable Access in Primary Medical Care programme, backed by a £250 million access fund, to set up 113 new surgeries in the 50 most underdoctored PCTs in England.

Officially, PCTs maintain that the new surgeries, serving 'at least' 6,000 patients, will each be staffed by four GPs.

But Phil Emmott, a health management consultant and former deputy chief executive of Bury PCT, says he has 'indications from colleagues that one doctor has to be vocationally trained but the others would not have to be'.

'By the time these surgeries are open it may be possible to staff them with junior doctors who haven't completed vocational training,' he said.

The grade would introduce a new type of primary care doctor below principals, salaried GPs, locums and registrars.

A DoH spokesman said: 'Actual staffing is a matter for local consultation.'

Professor Chris Drinkwater, president of the NHS Alliance, said the plan would help the government deal with the 'glut' of doctors completing their postgraduate training this year.

'It's market forces,' he said. 'If you've got an over supply of doctors, you can force down wages.'

The new staff-grade doctors would need to be supervised, but 'there are no clear criteria for what "supervised" means', he added.

Medical directors and directors of clinical services at the new surgeries have to be GPs, under specifications sent to PCTs by the DoH. But it has not sent specifications for other doctors.

At present, GPs cannot practice unless they are listed on the GP register, for which they require vocational training. But these rules could be amended by primary legislation.

Deputy GPC chairman Dr Richard Vautrey said: 'It confirms our fears that patients will be offered a lower standard of general practice through the Darzi centres.'

The new practices should aim to be accredited to offer training to medics from the first postgraduate to the last year of GP training within 18 months of opening, the DoH has said.

Dr Bob Wood, a GP from Heady Hill Surgery, Heywood, Lancashire, accused the DoH of 'de-skilling' and introducing a kind of 'sub-GP grade'.

'The public will be going to a Darzi surgery thinking they are going to see a GP,' he said. 'This is a way of doing general practice with less qualified staff and more cheaply.'

PCTs will receive a fixed sum of £708,000 in 2009/10 and £1,150,000 in 2010/11 for each Darzi surgery they open.

prisca.middlemiss@haymarket.com

Comment below and tell us what you think